<%@ page language="java" import="java.util.*" pageEncoding="utf-8"%>
<%
String path = request.getContextPath();
String basePath = request.getScheme()+"://"+request.getServerName()+":"+request.getServerPort()+path+"/";
%>

<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 1.0 Transitional//EN">
<html>
  <head>
    
    <title>添加客户信息</title>
    
	<meta http-equiv="pragma" content="no-cache">
	<meta http-equiv="cache-control" content="no-cache">
	<meta http-equiv="expires" content="0">    
	<meta http-equiv="keywords" content="keyword1,keyword2,keyword3">
	<meta http-equiv="description" content="This is my page">
	<!--
	<link rel="stylesheet" type="text/css" href="styles.css">
	-->

  </head>
  
  <body>
  
<div class="pageContent">
	<form method="post"  action="<%=basePath %>customer_add_List.action" class="pageForm required-validate" onsubmit="return validateCallback(this);">
		<div class="pageFormContent" layoutH="56">
			
			<p>
				<label>客户姓名：</label>
				<input name="customer.cname" class="required" type="text" size="16" value="" alt="请输入客户名称"/>
			</p>
			<p>
				<label>身份证号：</label>
				<input name="customer.cardId" class="required" type="text" size="24" maxlength="18" value="" alt="请输入客户身份证编号"/>
			</p>
			<p>
				<label>性别：</label>
				<select name="customer.cgender" class="required combox">
					<option value="">请选择</option>
					<option value="男" selected>男</option>
					<option value="女" >女</option>
				</select>
			</p>
			<p>
				<label>年龄：</label>
				<input name="customer.cage" class="digits" type="text" size="8"  maxlength="3" alt="请输入数字" onkeyup="javascript:this.value=this.value.replace(/[^\d]/g,'');
if(this.value<0){
this.value=0;};
if(this.value>200){this.value=200;}"
 onchange="javascript:this.value=this.value.replace(/[^\d]/g,'');
if(this.value<0){
this.value=0;};
if(this.value>200){this.value=200;}" /> 
				
			</p>
			<p>
				<label>婚姻状况：</label>
				<select name="customer.isMarried" class="required combox">
					<option value="">请选择</option>
					<option value="true">是</option>
					<option value="false" selected>否</option>
				</select>
			</p>
			<p>
				<label>职业：</label>
				<input type="text" size="16" name="customer.occupational"/>
			</p>
			<p>
				<label>血型：</label>
				<select name="customer.bloodGroup" class="required combox">
					<option value="">请选择</option>
					<option value="A" selected>A</option>
					<option value="B" >B</option>
					<option value="AB" >AB</option>
					<option value="O">O</option>
				</select>
			</p>
			<p>
				<label>文化程度：</label>
				<select name="customer.education" class="required combox">
					<option value="">请选择</option>
					<option value="小学">小学</option>
					<option value="初中" >初中</option>
					<option value="高中" >高中</option>
					<option value="大学及以上" selected>大学及以上</option>
				</select>
			</p>
			<p>
				<label>家庭住址：</label>
				<input type="text" name="customer.caddr"  size="32" />
			</p>
			<p>
				<label>工作单位：</label>
				<input type="text" size="30" name="customer.company"   />
			</p>
			<p>
				<label>RH阴性：</label>
				<select name="customer.rhNegative" class="required combox">
					<option value="">请选择</option>
					<option value="+">+</option>
					<option value="-" selected>-</option>
				</select>
			</p>
			<p>
				<label>户籍地址：</label>
				<input type="text" size="32" name="customer.homeTown" />
			</p>
			<p>
				<label>患者来源：</label>
				<input type="text" size="32" name="customer.fromSrc"/>
			</p>
			<p>
				<label>医保方式：</label>
				<input type="text" size="16"  name="customer.medicalInsurance" />
			</p>
			<p>
				<label>患者习惯：</label>
				<input type="text" size="32"  name="customer.habits"/>
			</p>
			
			<p>
				<label>残疾证号：</label>
				<input type="text" size="30" maxlength="20" name="customer.disabilityId"/>
			</p>
			<p>
				<label>是否残疾：</label>
				<select name="customer.isDisability"  class="required combox">
					<option value="">请选择</option>
					<option value="true">是</option>
					<option value="false" selected>否</option>
				</select>
			</p>
			
		</div>
		<div class="formBar">
			<ul>
				<!--<li><a class="buttonActive" href="javascript:;"><span>保存</span></a></li>-->
				<li><div class="buttonActive"><div class="buttonContent"><button type="submit">保存</button></div></div></li>
				<li>
					<div class="button"><div class="buttonContent"><button type="button" class="close">取消</button></div></div>
				</li>
			</ul>
		</div>
	</form>
</div>

                             
  </body>
</html>
